It’s been more than two years since the Arizona Department of Corrections agreed to reform its prison healthcare system. But the DOC is still not in compliance with court orders that affect the more than 34,000 people held in Arizona prisons.

The Eighth Amendment to the Constitution prohibits cruel and unusual punishment and that has been interpreted to entitle prisoners to reasonably adequate health care.

“Prisoners can’t take care of their own healthcare needs," said David Fathi, director of the ACLU National Prison Project. "They can’t go to the doctor themselves. They’re locked up. So the state is legally required to provide for their medical and mental health and dental care needs."

In 2012, the ACLU sued the state on behalf of a plaintiff class Arizona prisoners, alleging that the health care provided by the Department Of Corrections was so bad that it violated the Eighth Amendment.

Cruel And Unusual

Jonathon Trethewey is a member of that plaintiff class. He said “cruel and unusual” is an understatement.

"You’re made to feel less than human and you’re being neglected and you’re being mentally abused," Tretheway said. "It feels like you’re being tortured."

He spent seven years in the Department of Corrections struggling with major health issues. After his release, Trethewey founded the Atlas Justice Center to help advocate for the rights of the incarcerated.

At a recent board meeting in a Tempe coffee shop, he recalled hid first symptoms in a Tucson prison. "In my lower left stomach, I was having really sharp pains. And when I would push on that area, I would feel a mass and the pain would increase.”

When he started seeing blood in his stool, he put in what’s called a Health Needs Request. DOC’s own policies say after submitting a request, prisoners are supposed to be seen by a registered nurse within 24 hours. But Trethewey said it was six months before he got a response and two more before he saw a physician.

“(The doctor) looked at me, asked me to lift my shirt, said that I looked healthy and then gave me a medication for ulcer - ulcer medication,” Tretheway said.

The physician told him the swelling in his stomach was probably just gas. But it got worse.

Months went by and Trethewey’s condition got so bad his fellow inmates threatened to riot if he didn’t receive medical attention. By the time DOC finally got him to the hospital, it turns out it wasn’t gas - it was colon cancer.

“My tumor had metastasized to the point where it completely blocked off my intestines and that’s why I was getting sick and got septicemia,” Tretheway said.

Monitoring Process Lacks Consistency

Trethewey would go on to fight both the cancer and the system. He joined the plaintiff class in Parsons v Ryan that ended up settling with the Department of Corrections.

In 2015 a federal court mandated the DOC comply with 103 stipulations to improve conditions in the state prison health care system, but the ACLU’s David Fathi said recent hearings show that DOC, which is monitoring its own compliance - just isn’t getting the job done.

"The picture that is emerging is of a haphazard, make it up as you go along system that has very little training and oversight and very little consistency in how the monitoring is done,” Fathi said.

So far, the plaintiffs and the state haven’t come to an agreement on just how many of the Health Performance Measures have been met. In a statement, ADOC said “The ACLU’s allegations are unsupported by the evidence.” At a recent status hearing, the state claimed it met the standard for timely access to care for the month of January at all of the state prisons it sampled.

But Fathi said if you look at the same data over the course of a year, DOC is woefully non-compliant. He said recent witness testimony shows that the monitors need more guidance and direction and that their sampling model is anything but random:

"I’m reminded of the saying, garbage in, garbage out," Fathi said. "If the monitoring isn’t being done properly and consistently and rigorously then the results are meaningless.”

DOC contracts with a private health-care provider called Corizon Health. Spokesperson Martha Harbin said that claims of Corizon and DOC putting off diagnoses and delaying access to treatment are unfounded, "To the contrary, what makes good medical sense and good business sense is excellent and proactive preventive care.”

Prison Health Is Public Health

Marc Stern teaches correctional health care in the School of Public Health at the University of Washington. "Prison health is public health,” Stern said. He points out that almost 1 percent of the adult population in the United States is currently behind bars.

Stern said even if you don’t really care about their rights, it behooves the rest of us to ensure prisoners get proper care. “So that when they come back to society, they’re healthier, they contribute, they don’t use up hospitals and emergency rooms and jails - that’s a way of caring for ourselves.”

Jonathon Trethewey is a testament to that line of thinking. He’s moving on with his life and his cancer is in remission. But he said we can’t forget about the tens of thousands that are still suffering behind bars in Arizona.

“The yards are full of people with cancer and medical conditions that have to struggle with these same things, over and over again you see it everywhere, it’s so commonplace in prison, and you really feel like you have no voice,” Tretheway said.

He said it’s up to society to speak for them. And it’s the responsibility of the state to live up to the Parsons settlement, so that prisoners are treated with the dignity and respect they deserve.

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